CK Yeung, SM Ip, KH Lee, K Liu, AKC Li

High swinging fever after reduction of intussusception is very common. It has been widely believed that this is caused by a transient bacteraemia or endotoxaemia as a result of bacterial translocation through the strangulated intestinal wall. This belief has often led to unnecessary septic workup and empirical prescription of broad spectrum antibiotics.

Aims To evaluate the significance of bacteraemia, endotoxaemia and cytokine release in the production of fever in childhood intussusception.

Methods All infants and children with intussusception were recruited over a 2-year period. Each had blood for culture/sensitivity, serum levels for endotoxin, tumour necrosis factor alpha (TNF-α), interleukin-1β (IL-1β) and interleukin-6 (IL-6) just before and 24 hours after reduction. These were correlated with the success of pneumatic reduction and the occurrence of febrile episodes.

Results 76 infants and children aged 2 months to 8 years (mean: 12 months) were studied. Fifty-seven had successful pneumatic reduction and 19 underwent surgical reduction.

Positive blood cultures were obtained in only 5 patients after reduction and these were not related to the occurrence of fever.

Conclusions Febrile episodes in childhood intussusception, both pre- and post-reduction, are significantly related to the release of interleukin-6. Septic workup and antibiotics are not required in their management in the great majority.